Volume 107, Issue 8 (December 2008)

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Abstract

As the 155th president of the Wisconsin Medical Society, Steven C. Bergin, MD, has worked to highlight the need for health system reform and the critical condition of our current system. With the recent elections and a wave of change on its way to Washington D.C., it is clear that now is the time for health system reform. This issue of the Wisconsin Medical Journal showcases different perspectives on health system reform and areas that need reform now.

Focus On… Health System Reform

The time is critical

Steven C. Bergin, MD, President, Wisconsin Medical Society

Our patient is arousable but becoming increasingly more incoherent. Cries of despair punctuate the surrounding silence. The periodic facial contortions associated with guttural moans and groans express chronic internal pain. The eyes reveal fear, anxiety, and anguish. The skin is cold and clammy, and the body is limp and flaccid. The blood pressure is slowly dropping, and the pulse is thready and weak. The breathing is shallow and labored.

Author Affiliations:Dr Bergin is an OB/GYN in Stevens Point, Wis and president of the Wisconsin Medical Society.

Your patients are waiting… for your leadership

Until October of 2008, I practiced family medicine for 16 years in a semi-rural community. I watched diabetic patients decide between rent, hamburger, or insulin. I took care of a healthy farming couple, both 55 years old, whose insurance cost $900 per month with a $15,000 deductible. In the event of an illness, they planned to sell a tractor to cover that deductible. When patients and other citizens sometimes need health care but can’t afford it, I—along with other physicians—am indignant that in what is still the richest nation in the world, where we spend 16.3% of our Gross Domestic Product (GDP) on health care, citizens are unable to see their doctor.

The ailing health care system: SOAP note for physician leadership

Donna Friedsam, MPH; Richard Rieselbach, MD, MACP

Health care reform. The oft-used phrase has launched endless political debates and stimulated volumes of literature. Yet physicians, immersed and busy in the daily provision of care for their patients, often remain on the periphery of the health care reform dialogue. Now, timing and recent research in Wisconsin and elsewhere demand that physicians take time to visit with the current ailing patient—our health care delivery system.

Author Affiliations:Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wis (Friedsam); Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis (Rieselbach).

Is there a doctor in the ‘home’?

Jeff Grossman, MD

Because of my job, I’m frequently asked by friends and colleagues to recommend a physician. Without much trouble, I can name an exceptional doctor in any one of more than a hundred sub-specialties, depending on the problem at hand. But ask me to find a general internist or family physician, and I’ve got a problem. Our large, multi-specialty group has a shortage of these doctors, most of whose practices do not accept new patients.

Short Report: Factors that Affect Specialty Choice and Career Plans of Wisconsin’s Medical Students

Objective: To identify factors that influence specialty choice among Wisconsin medical students and provide insight into approaches to encourage more students to pursue careers in primary care.

Methods: The importance of several factors in medical student career choice was surveyed using a Web survey convenience sample of all Wisconsin medical students. Students intending to pursue a career in primary care and in other specialties were compared.

Results: Respondents, regardless of specialty choice or gender, identified a similar group of factors as highly influential, and similar group of factors as non-influential in their decision-making. However, significantly more primary care students than other specialty students considered interest in underserved populations, relationships with patients, scope of practice, and role models important in their career choice. Significantly more primary care students than other specialty students responded that salary and competitiveness were “not at all” important. A greater number of other specialty students than primary care students stated that interest in scope of practice, role models, and training years were “not at all” important. Debt-related factors were reported as “not at all” important by nearly one-third of respondents.

Conclusions: Although primary care and other specialty students report making their career plans based on the impact of similar factors, significant differences between primary care and other specialty students were reported in key areas. These results validate many previously reported factors, and indicate that salary and years of training may have been overemphasized in understanding student career choice. The results of this survey may be useful for Wisconsin medical schools in order to sustain, support, and foster student interest in primary care.

Author Affiliations:University of Wisconsin School of Medicine and Public Health, Madison, Wis (Knox, Getzin, McBride, Rieselbach);
University of Wisconsin School of Medicine and Public Health, UW Population Health Institute, Madison, Wis (Bergum, Friedsam); Wisconsin

Navigating the Health Care System: A View from the Urban Medically Underserved

Objective: The purpose of this project was to discover areas identified by minority and underserved patients that lead to dissatisfaction with the health care system and specific areas identified as barriers to health.

Methods: Six focus groups (n=25) were conducted, with
participants including mostly poor African-American adults with and without a primary care home, in addition to 1 group of community dwelling mentally ill patients, and 1 group of case managers for community dwelling mentally ill patients who navigate the health care system for their clients. Qualitative analysis by 3 authors identified themes emerging from the focus groups.

Results: The following themes were identified: (1) difficulty with insurance, including coverage, accessibility, stability, and choices; (2) socioeconomic, more than racial, barriers to care; (3) a misunderstanding or lack of information about the health care system and a lack of health literacy; and (4) lack of personal accountability for health and health care.

Discussion: Patients with access to a primary care home seemed more satisfied with the health care system. An increase in health literacy education and simplification of insurance policies and procedures could increase satisfaction and possibly improve outcomes for underserved patients. Providing preventive care and improving patient accountability for personal health may also improve satisfaction and outcomes.

Collaboration Saves Time

Philip A. Bain, MD, FACP

Caring for patients today is very complicated and involves many clinical and administrative tasks. Clinicians are often asked to fill out a wide variety of forms, including forms that verify that the patient’s clinical status is stable. Currently, these forms are filled out manually by the clinician or staff. Clinicians use electronic medical records (EMRs) have the potential for significant time savings if the EMR can be used to eliminate manually loading data already housed in the EMR.

This article describes how collaboration between a government agency and a medical group that uses the Epic EMR resulted in an electronic version of a commonly used form. Once implemented, this form resulted in a significant time savings for the clinician. It is hoped that this project will serve as a template for future similar projects that could result in more efficient use of clinician and office staff’s time.

Your Practice

Follow your plan for retirement

Christopher P. Thomas

When you tell your patients they need to lose weight, exercise, or stop smoking, they sigh and nod their heads in agreement. When your financial adviser tells you that you need to save for retirement, do you respond likewise?

Recent market volatility sometimes makes you rethink your plan and tolerance for risk. Lifestyle changes require effort and self-discipline, but the long-term rewards can be great. Here are some recommendations to help you get started on the right path.

Advancing outpatient prevention: A new MetaStar project

Jay A. Gold, MD, JD, MPH

MetaStar is currently recruiting primary care physician practices for a new Medicare project that will use clinical data to identify barriers and gaps to providing necessary care and to identify and track interventions to improve patient outcome. The key methods of eliciting improvement are health information technology and care management processes.

Author Affiliations:Dr Gold is Senior Vice President and Chief Medical Officer of MetaStar, Inc. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contract with the Centers for Medicare & Medicaid Services (CMS). The co

Your Profession

Partnerships are most effective tool for eliminating disparities

Jonathan I. Ravdin, MD

What separates those with easy access to quality health care from those without? What separates those who have a higher disease burden and poorer outcomes from those who can expect longer, healthier lives? In some cases, it’s no more than a property line, but geography is only part of the equation.

The disparities in health and health care that weigh heavily on our communities are also based on age, ethnicity, gender, and economics, or a combination thereof. These factors can result in disadvantages that efforts by individuals or their health care professionals are unlikely to overcome. Partnerships, however, have proven effective as tools for restoring parity to the health care system.

Author Affiliations:Dean and Executive Vice President, Medical College of Wisconsin

The Americans with Disabilities Amendment Act—Are you ready for the changes?

Michelle Leiker, JD

On January 1, 2009, the Americans with Disabilities Act Amendment Act (Act), the most comprehensive change to the American with Disabilities Act (ADA) within the last decade, will take effect. The Act will require both large and small employers to completely overhaul their approach to reasonable accommodation requests from employees under the ADA.

Other

Proceedings from the 2008 Wisconsin Quality and Safety Forum, Part I

In 2008, quality and safety improvement initiatives in Wisconsin focused on developing an organization-wide culture of quality, and implementing processes to improve patient care and satisfaction. Below are descriptions of improvement projects undertaken by hospitals and other health care organizations, and showcased at the Wisconsin Hospital Association’s 2008 Wisconsin Quality & Safety Forum. The projects are broken into 6 categories; clinical improvement, infection control, customer service, medications, performance improvement, and safety. The last 3 categories will be published in the next issue of the Journal.